Chapter 21 - Lower Urinary Tract and Male Genital System Flashcards
0
Q
Conditions where fibrous proliferative inflammatory processes encase the retro peritoneal structures and lead to hydronephrosis
A
Sclerosis retroperitoneal fibrosis
1
Q
What is urethritis cystica? And in what conditions is it seen in
A
Inflammation of the ureters where the mucosa is sprinkled with fine cysts and lined with flattened urothelium
2
Q
What are some causes of sclerosing retroperitoneal fibrosis, which is the most common (4)
A
Drugs (ergot derivatives), adjacent inflammatory conditions, malignant disease, 70 % are primary/idiopathic
3
Q
What diseases show similar fibrosis and are found with sclerosing retroperitoneal fibrosis but are not retroperitoneal diseases
A
Mediastinal fibrosis sclerosing cholangitis, Riedel fibrosing thyroiditis
4
Q
What is idiopathic sclerosing retroperitoneal fibrosis called
A
Ormond disease
5
Q
What are some common causes of ureteral obstruction (2)
A
Transitional cell carcinomas in ureters and calculi (commonly less than 5mm diameter)
6
Q
What sites can calculi cause ureteral narrowing in
A
Ureteropelvic junction, where ureters cross iliac vessels, and where they enter bladder –> causes colic
7
Q
Acquired diverticulitis in the urinary bladder are most commonly seen with what condition? And how does this lead to the diverticulitis
A
Prostatic enlargement –> obstructs urine outflow –> increases intravescical pressure causing outpouching of the wall
8
Q
Why are diverticula clinically significant (what can they lead to) (3)
A
Cause urinary stasis, predispose to infection, may form bladder calculi
9
Q
Where is the defect in exstrophy of the bladder
A
Anterior wall of the abdomen and bladder
10
Q
What are some risks associated with exstrophy of the bladder (3)
A
Colonic glandular metaplasia, subject to infection, increased risk of Adenocarcinoma
11
Q
Most common congenital anomaly of the bladder
A
Vesicoureteral reflux
12
Q
How can you pee out of your belly button
A
Urachus (canal connecting fetal bladder with allantois) remains patent. If it’s only partially patent you can get a urachal cyst
13
Q
What can arise from urachal cysts
A
Glandular tumors, account for 20-40% of bladder adenocarcinomas but only small percent of all bladder cancers
14
Q
Predisposing factors to cystitis
A
Urinary obstruction and diabetes mellitus
15
Q
Infectious agents of cystitis, what is most common, who is most likely affected men or women
A
E.coli (most common), schistosomiasis, viruses, chlamydia, mycoplasma; more common in women because of their shorter urethras
16
Q
What can cause hemorrhagic cystitis
A
Cytotoxic anti tumor drugs (cyclophosphamide) and adenovirus
17
Q
Symptoms of cystitis
A
Frequency, lower abdominal/suprapubic pain, dysuria
18
Q
What is related to chronic bacterial infection of the bladder? What species are commonly involved
A
Malakoplakia, e.coli commonly and sometimes proteus
19
Q
What is malakoplakia
A
Soft yellow raised mucosal plaques with large foamy macrophages (sometimes with michaelis-gutmann bodies - deposition of calcium)
20
Q
Why do the macrophages turn out the way they do in malacoplakia
A
Overloaded with undigested bacterial products
21
Q
What is associated with inflammation and metaplasia of the bladder but is not associated with an increased risk for Adenocarcinoma
A
Cystitis glandular is and cystitis cystica
22
Q
90% of all bladder tumors
A
Urothelial or transitional tumors
23
Q
What are the two precursor lesions to invasive urothelial carcinoma, which is the most common
A
Non-invasive papillary tumors (most common) and flat invasive papillary tumors
24
What grade are papillary urothelial tumors
Low grade tumors
25
Papillomas in the bladder usually present in what population
Younger generation
26
High grade papillary urothelial cancers have a high incidence of invasion into what layer of the bladder
Muscular
27
Invasive urothelial cancer may be associated with what conditions
Papillary urothelial cancer or carcinoma in situ
28
Squamous cell carcinomas of the bladder are related to what?
Schistosomiasis in endemic areas like Egypt
29
If you have a mixed urothelial carcinoma with areas of squamous carcinoma, what can the tumor abundantly produce if it's highly differentiated
Keratin
30
Incidence of bladder carcinoma is higher in what population
Men in developed urban nations between the ages of 50-80 years
31
What are some risk factors to bladder carcinoma, which has the most important influence
Cigarette smoking is most important (cigars pipes and smokeless tobacco have less of a risk), industrial exposure to arylamines (2-naphthylamine), schistosoma hematobium in endemic areas like Sudan and Egypt, long term exposure to cyclophosphamide
32
What genetic alterations are associated with bladder carcinoma
Chromosome 9 (papillary and non-invasive), tumor suppressor gene p16 (INK4a), also many show alterations in p53
33
Symptoms of bladder carcinoma
Painless hematuria, frequency, urgency, and dysuria
34
Treatment of bladder cancer
Transurethral resection, radical cystectomy, chemotherapy
35
How do sarcomas of the bladder look like grossly
Large masses that protrude into the vesicle lumen
36
The most common bladder sarcomas in infancy or childhood
Embryonic rhabdomyosarcoma
37
Secondary malignant involvement of the bladder usually involves what organs
Cervix and prostate
38
What are the two categories of urethritis
Gonococcal and nongonococcal
39
What can nongonococcal urethritis be caused by
E. coli and other bacteria, chlamydia
40
What is urethritis accompanied in men and women
Cystitis in women and prostatitis in men
41
What are the symptomatic components of Reiter syndrome
Arthritis, conjunctivitis, and urethritis
42
Small red painful mass about the urethral meatus
Urethral caruncle
43
What population is a urethral caruncle seen in
Older females
44
Histology of urethral caruncle
Inflamed granulation and a polyp
45
What can cause ulceration of the surface and bleeding of the urethral caruncle
Trauma
46
What does Peyronie disease result in
Fibrous bands involving the corpus cavernosum of the penis
48
Symptoms of Peyronie disease
Penile curvature and pain during intercourse
49
malformation of the _____ on the ventral side of penis
urethral groove --> hypospadius
50
malformation of the _____ on the dorsal side of the penis
urethral groove --> epispadius
51
hypospadias and epispadias is associated with what during development, which of the 2 is more common
failure of the normal descent of the testes, hypospadius is more common
52
what is a possible consequence in men that had hypospadius and epispadius
sterility
53
what is phimosis
prepuce is too small to permit normal retractions
54
what is the common etiology associated with phimosis
repeated attacks of infection that cause scarring of the preputial ring
55
balanoposthitis involves infection to what structures
the glans and prepuce
56
what are the likely organisms involved in balanoposthitis
Candida albicans, anaerobic bacteria, and pyogenic bacteria
57
most cases of balanoposthitis are associated with what in males
poor hygiene in uncircumcised males with smegma (desquamated epithelial cells, sweat and debris) acting as an irritant
58
most frequent HPV types causing condylomatat acuminata
type 6 and 11
59
characteristic histology in condylomata acuminatum
cytoplasmic vacuolization of the squamous cells (koilocytossis)
60
most common type of HPV associated Bowen disease and bowenoid papulosis
type 16
61
bowen disease invovles what part of the male
skin of the shaft of the penis and the scrotum
62
bowen disease affects males of what age group
over 35 years
63
histology of bown disease shows 3 things
hyperchromatic nuclei, lack orderly maturated with, intact basement membrane
64
10% of bowen disease may transform into
squamous cell carcinoma
65
how does bowenoid papulosis differ from bowen disease
younger age of patients and prescence of multple (instead of solitary) reddish brown papular lesions
66
what is the likelihood of bowenoid papulosis developing into an invasive carcinoma
almost never and spontaneously regresses
67
what protects from invasive carcinoma of the penis
circumcision
68
what elevates the risk of invasive carcinoma of the penis
HPV 16, 18, and cigarette smoking
69
what age group are invasive carcinomas of the penis usually found in
40-70 years old
70
in what area does the invasive carcinoma of the penis usually arise in
glans, inner surface of the prepuce near the coronal sulcus
71
what is the likelihood of invasive carcinoma of the penis metastasizing, and where would it go to
it rarely metastasizes, inguinal lymph nodes
72
what is the defect in cryptorchidism
complete or incomplete failure of the intra abdominal testes to descend into the scrotal sac
73
phases of testes descent and what occurs in each
transabdominal and inguinoscrotal phases
74
what happens during the transabdominal phase of testicular descent
testes at the lower abdomen at brim of pelvis controlled by mullerian-inhibitng substance
75
what happens during the inguinoscrotal phase of testicular descent
testes through the inguinal canal into the scrotal sac and is androgen dependent
76
what phase does the testes descent usually get interrupted in?
inguinoscrotal phase, usually palpable in the inguinal canal
77
how is cryptorchidism detected
patient or physician when the scrotal sac does not have a testes
78
cryptorchidism is usually:
- unilateral/bilateral?
- age histologic change seen
- histology?
unilateral, in 2 year olds, small testes and firm from fibrotic change
79
what other kind of pathology can be associated with cryptochidism
exposed to trauma and crushing against ligaments and bones
80
cryptochidism has an increased risk of:
testicular cancer
81
when should surgery occur in cryptochidism
after the first year because it may spontaneously descend before then, but before the patient is 2 years old before histologic change occurs
82
atrophy of the testis may result from:
(1) atherosclerosis blocking blood supply (2) advance inflammatory orchitis (3) cryptorchidism (4) hypopituitarism (5) malnutrition (6) irradiation (7) antiandrogens (8) exhaustion atrophy (9) genetics - like Klinefelters
83
causes of epididymitis in young men and elderly men
gram negative rods: younger than 35 (C. trachomatis, N. gohorrhoeae) and older than 35 (E.coli and Pseudomonas)
84
Is sexual activity affected in epididymitis? What does epididymitis eventually lead to?
fibrous scarring and sterility, but sexual activity is not disturbed
85
mumps may invovle what organs
swelling parotid glands and 1 week later, orchitis
86
if a tuberculosis infection involves the male orgins, where would it begin and spread
epididymis and spreads to the testis
87
what organ does syphilis first infect in the male?
the testis
88
morphology found in syphilis
gummas, a diffuse interstitial inflammation with edema and lymphocytic and plasma cell infiltration
89
pathogenesis of torsion testis
torsion --> thick walled arteries remain patent while veins collapse causing vascular engorgement and hemorrhagic infarction
90
how does torsion of the testis typically present
adolescence as a sudden onset of testicular pain
91
how does adult torsion of the testis differ from the infantile form
adult torsion results from a b/l anatomic defect where the testis has increased mobility --> bell clapper abnormality
92
where are the malignant paratesticular tumors most commonly located; what are the most common adult and child tumors called?
distal end of the spermatic cords; rhabdomyosarcomas in childrean and liposarcomas in adults
93
Two categories of testicular tumors
germ cell tumors and sex cord-stromal tumors
94
95% of testicular tumors arise from
germ cells
95
testicular germ cell tumors are divided into
seminomas and non seminomas
96
which of the two types of testicular tumors are benign and which is malignant
germ cell tumors (aggressive cancers) and sex cord-stromal tumors (benign)
97
most common tumor of men in the 15-24 age group, what race is it more common in
germ cell testicular tumors, more common in whites than blacks
98
what spectrum of disorders are testicular germ cell tumors associated with
testicular dysgenesis syndrome
99
what comprises testicular dysgenesis syndromes
crytorchidism, hypospadias, and poor sperm quality
100
most important risk factor for testicular germ cell tumors
cryptochidism
101
klinefelter syndrome is associated with an increased risk for what type of tumor
mediastinal germ cell tumor
102
difference between seminomas and non seminomas
seminomas (cells resemblin primordial germ cells) and non seminomas (undifferentiate cells that resemble embryonic stem cells
103
malignant forms of non seminomas
yolk sac tumors, choriocarcinomas and teratomas
104
most testicular germ cell tumors are comprised of what type of tumor
60% are a mixed seminoma and non-seminoma
105
most common type of testicular tumor
seminomas
106
mutation present in seminomas
c-KIT
107
How old are patients with a seminoma
third decade
108
female equivalent of a seminoma
dysgerminoma
109
seminoma morphology
gray white mass w/o necrosis or hemorrhage and has a distinct cell membrane, clear cytoplasm and a large central nucleus
110
a small percent of seminomas may secrete
HCG from syncytiotrophoblasts
111
age group and prognosis of testicular embryonal carcinoma
20-30 years and aggressive
112
morphology of embyonal carcinoma of testes
foci of hemorrhage and necrosis and lacks well formed glands
113
age group affected in a testicular yolk sac tumor
infants and children up to 3 years of age
114
morphology of testicular yolk sac tumor
lacelike/reticular network of cuboidal flattened cells, schiller-duval bodies (like endodermal sinuses- mesodermal core layer of cells resembling glomeruli)
115
Characteristic marker found in testicular yolk sac tumors
alpha fetoprotein, and sometimes alpha 1 antitrypsin
116
prognosis of testicular choriocarcinoma
highly malignant
117
cell types found in testicular choriocarcinoma
syncytiotrophoblastic cells and cytotrophoblastic cells
118
hormone found in the cytoplasm of testicular choriocarcinoma
HCG
119
testicular tumor with various components of more than one germ layer
teratoma
120
what age group do teratomas appear in
infancy to adult
121
difference between teratomas in the child and adult
child (benign course) and in post pubertal male all teratomas are malignant
122
painless enlargement of the testis is characteristic of
germ cell neoplasms
123
mode of metastasis in germ cell tumors
lymphatic spread to retroperitoneal para-aortic nodes, then to mediastinal and suprclavicular nodes . hematogenous spread to the lungs (possibly liver brain bones)
124
most aggressive testicular germ cell tumor
pure choriocarcinoma
125
which is worse, seminoma or non seminoma
non seminoma because they metastasize earlier and use the hematogenous route
126
which testicular germ cell tumor is radiosensitive and radioresistant?
seminomas (radiosensitive) and non seminoma germ cell tumors (radioresistant)
127
what does lactate dehydrogenase correlate with in germ cell tumors
lactate dehydrogenase indicates the mass of tumor cells
128
which germ cell tumor has the best prognosis
radiosensitive
129
symptoms of leydig cell tumors
testicular swelling and gynecomastia and sexual precocity
130
what histology do you see with leydig cell tumors
rod shaped crystalloids of Reinke
131
what hormone do sertoli cell tumors present with
NONE
132
most sertoli cell tumors are benign/malignant
benign
133
most common form of testicular neoplasm in men over the age of 60
testicular lymphoma
134
most common testicular lymphoma
diffuse large Bcell lymphoma
135
what is hydrocele
serous fluid in the tunica vaginalis and can be seen with transillumination. also, hematocele, permatocele and varicocele (dilated veins)
136
retroperitoneal organ encircling neck of bladder and urethra and devoid of a distinct capsule
prostate
137
most hyperplasia of the prostate arise in what zone
transitional zone
138
most carcinomas of the prostate arise in the
peripheral zone
139
prostate is composed of glands layered with:
two layers of cells: a basal layer of low cuboidal epithelium covered by a layer of columnar secretory cells
140
what controls the growth and survival of prostatic cells
testicular androgens
141
most common cause of acute bacterial prostatitis
E. coli then other gram negative rods, enterococci and staphylococci
142
how does bacteria become implanted in the prostate?
reflux of urine from the posterior urethra or bladder or from lymphetagenous route from distant infection foci
143
symptoms of acute bacterial prostatits
fever, chills and dysuria with a tender and boggy prostate
144
symptoms of chronic bacterial prostatitis
low back pain, dysuria, suprapubic discomfort. PATIENTS HAVE A HISTORY OF RECURRENT URINARY TRACT INFECTIONS FROM THE SAME ORGANISM
145
labs for chronic bacterial prostatitis
leukocytosis with + bacterial cultures
146
most common form of prostatitis
chronic abacterial
147
how to distinguish chronic bacterial prostatitis from abacterial prostatitis
NO HISTORY OF RECURRENT URINARY TRACT INFECTION
148
labs for abacterial prostatitis
slightly elevated leukocytes but - bacterial cultures
149
what is contraindicated in a man with acute prostatitis
biopsy --> can lead to sepsis
150
where do nodules occur in benighn prostatic hyperplasia
periurethral region
151
incidence of BPH in men by age group
20% by 40, 70% by 60 and 90% by 80
152
main androgen of the prostate
dihydrotestosterone (DHT)
153
which type of cells are responsible for androgen dependent prostatic growth
stromal cells because they contain 5alpha-reductase which converts testosterone to DHT
154
what is the consistency of prostate nodules in BPH
mostly glands and the tissue is yellow pink with a soft consistency and milky white prostatic fluid oozes out of these areas
155
hallmark of BPH
nodularity
156
how is diagnosis of BPH made
needle biopsy
157
symptoms of BPH
urinary frequency, nocturia, difficulty in starting/stopping the stream of urine --> increased risk of infection
158
things to help with BPH
monitor caffeine/alcohol
159
gold standard of reducing symptoms for BPH
transurethral resection of prostate TURP
160
most common form of cancer in men
adenocarcinoma of the prostate
161
what age group does cancer of the prostate affect
men over the age of 50
162
when should screening prostate cancer begin?
age 40
163
what race is prostatic cancer common/uncommon in
uncommon in Asians and frequently in Blacks
164
environmental/lifestyle factor that has been implicated in prostate cancer
increased consumption of fats
165
growth and survival of prostate cancer cells depends on
androgens
166
why can't androgen blockade be a permanent treatment for prostate cancer
most tumors eventually become resistant to androgen blockade
167
men with a first degree relative of prostate cancer have __ the risk of developing prostate cancer
2x the risk
168
what part of the prostate does adenocarcinoma arise in
peripheral zone, palpable on rectal exam
169
metastasis of prostate cancer
via lymphatics to obturator nodes and then to para-aortic nodes. hematogenous spread to bones (axial skeleton-lumbar spine, femur, pelvis, thoracic spine, ribs)
170
morphology of prostate cancer glands
crowded, lack branching, and basal cell layer is absent
171
precursor lesions for prostate cancer
high grade prostatic intraepithelial neoplasia
172
what does PIN precursor lesion of prostate cancer usually contain
benign prostatic acini lined by cytologically atypical cells with prominent nucleoli
173
where does PIN precursor lesion of prostate cancer typically occur
peripheral zone
174
gleason system
grading for prostate cancer --> 2 grades added: 8-10 is worst prognosis
175
symptoms of prostate cancer
late appearing urinary symptoms, PSA, BPH symptoms, back pain from vertebral metastisis
176
normal and abnormal PSA cutoff
4ng/mL
177
is elevated PSA only seen with prostate cancer
no its organ specific not cancer specific so could be seen in BPH
178
PSA levels at 40-49, 50-59, 60-69, 70-79
2.5ng/mL, 3.5ng/mL, 4.5ng/mL, 6.5ng/mL
179
how many PSA tests are required per year
3 in 1.5-2 years
180
what PSA level is lower in men with cancer than with PBH
free PSA percentage
